Recipient of Baboon Liver Dies After Severe Stroke

By LAWRENCE K. ALTMAN

Published: September 7, 1992

The world's first recipient of a baboon liver died last night, about seven hours after suffering a massive stroke at the University of Pittsburgh Medical Center, hospital officials said.

The patient died at 9:45 P.M. at the hospital where the 11-hour transplant operation was performed on June 28. The stroke occurred suddenly about 3 P.M., while doctors were trying to wean the patient from a mechanical ventilator, Dr. Howard R. Doyle, a surgeon on the transplant team, said in an interview.

The patient, a 35-year-old man whose identity was withheld at his request, lapsed into a coma after the stroke. Officials said an autopsy would be performed today.

At least 33 attempts at animal-to-human organ transplants have been made since 1905. The longest anyone has survived after such an operation is nine months. The patient in the record-setting case had received a kidney from a chimpanzee in an operation at Tulane Medical School in New Orleans in 1963. The patient in this case lived for 70 days after his transplant. Recent Improvement

Until the stroke yesterday, the patient had been improving from a serious setback that he suffered on Aug. 28 after an X-ray test. The man went into shock about one hour after the procedure and doctors said they suspected that when as part of the procedure they manipulated bile ducts in the liver with needles, bacteria spread through the blood.

After the setback, the patient's bilirubin, a measure of liver function, rose to about 50, from a normal level of one. By yesterday, it had dropped to 25. Doctors had said they were not certain of the diagnosis and said they had not ruled out an unusual type of rejection reaction not seen in transplants of human organs.

In recent days the patient showed improvement.

"He was getting better," Dr. Doyle said. "He was wide awake this morning and we were working to get him off the respirator" completely.

But at 3 P.M., the patient's blood pressure dropped suddenly and he was unresponsive, Dr. Doyle said. A scan showed a large amount of bleeding in the brain, Dr. Doyle said.

Dr. Doyle said the medical team suspected that the stroke resulted from bleeding from an aneurysm in an artery feeding his brain. The doctors also suspect that the aneurysm might have become infected from bacteria from infections that the patient suffered during his recovery. In an addition to the episode on Aug. 28, the man experienced three episodes of serious infection since he received the baboon liver on June 28. "Any of them could have caused" an infection in an aneurysm, Dr. Doyle said.

Dr. Thomas E. Starzl, the transplant pioneer who has overseen the patient's care, said that serious neurological problems like strokes occur in about 10 percent of transplant patients receiving human livers.

The experiment at the University of Pittsburgh was undertaken in hopes of solving a critical shortage of human organs and saving the lives of thousands of patients who die before they can receive one.

The liver of the patient in this case was destroyed by hepatitis B, a virus that also destroys transplanted human livers. Doctors had done the transplant in the hopes that the baboon liver would not be susceptible to the disease.